Pericranial Flap for Endoscopic Anterior Skull Base Reconstruction: Clinical Outcomes and Radioanatomic Analysis of Preoperative Planning

Abstract

Object: One of the major challenges of cranial base surgery is reconstruction of the dural defect and prevention of postoperative CSF fistula. Following a craniofacial resection, the standard reconstructive technique is direct suture repair of the dural defect with a graft and rotation of an anteriorly based pericranial scalp flap to cover the dura. The introduction of endoscopic techniques and an endonasal approach to the ventral skull base has created new challenges for reconstruction. The nasoseptal flap has become the workhorse for vascularized endoscopic skull base reconstruction; however, at times the septal mucosal flap may be unavailable for reconstruction. This can be due to prior surgical resection or involvement of the nasal septum by sinonasal cancer. Recently, we developed a minimally invasive endoscopic pericranial flap for endoscopic skull base reconstruction. We present the initial cohort of patients that had endonasal reconstruction with a pericranial flap after endoscopic skull base resection. We also demonstrate a method to radiographically incorporate anticipated skull base defects for preoperative planning of pericranial flap length.